Preceptorship Application — North Carolina AIDS Training and Education Center

(click here for print version)

Tell Us About Yourself

First Name

Last Name

Profession

Please provide the mailing address of the health care facility at which you are employed.

Name of facility

Street

City

State

Zip Code

HIV training topics of particular interest to you (e.g. adherence, HIV 101)

Contact information

E-Mail Address

Telephone

Fax

Pager

Locations for preceptorship

Preceptorships typically take place at UNC Memorial Hospital or the Durham County Health Department. Financial support for travel may be available.

Application submission and next steps

Click the button below to submit this application electronically. Once an initial application has been approved and training needs have been established, location, training objectives and a preceptorship contract will be arranged.